746: Primary maternal cytomegalovirus infections: how accurate is fetal ultrasound to predict sequelae in the offspring?

ObjectiveEvaluation of fetal ultrasound (US) accuracy for prediction of sequelae in congenital cytomegalovirus (cCMV) infected fetuses after maternal primary CMV infection.Study DesignWe conducted a prospective observational study between 1996 and 2012. 67 pregnant patients (69 fetuses) were included with serological evidences of maternal primary CMV infection and proven vertical transmission to the fetus (positive CMV viral load on amniotic fluid or positive viral culture of the neonate). Fetal US was performed in all patients. Termination of the pregnancy (TOP) was presented as an option for CMV infected fetuses. Hearing and neurological clinical assessments were performed for all neonates with a CMV positive urine sampling.Results67 patients (69 fetuses) with a proven vertical transmission were included in this study, 64 singleton pregnancies and 3 twin pregnancies. 8 fetuses were excluded from the analysis because of insufficient data on the outcomes. Of the remaining 61, TOP was performed for 26 fetuses. In this group, 11 presented fetal US anomalies. Autopsy confirmed histological evidences of fetal CMV infection in all cases. In the 15 fetuses without fetal US anomalies, histological evidence of fetal infection damage was detected in 13 cases. Of the 35 live born infants, 12 had fetal US anomalies suggestive for cCMV infection. Of these 12 infants, 6 had a normal clinical evaluation whereas 6 presented with clinical anomalies from whom 4 cases were considered as severe. In 23 live born children with normal fetal US, 6 infants showed hearing impairments and 2 were diagnosed with mild neurological sequelae.ConclusionIn a group of maternal primary CMV infection acquired in early pregnancy, with proven fetal infection, fetal US anomalies were detected in 37,7% and were confirmed in autopsy or clinical evaluation after birth in 73,9%. In patients with normal fetal US evaluation, autopsy or clinical evaluation after birth could detect CMV-related anomalies in 55% of the patients. ObjectiveEvaluation of fetal ultrasound (US) accuracy for prediction of sequelae in congenital cytomegalovirus (cCMV) infected fetuses after maternal primary CMV infection. Evaluation of fetal ultrasound (US) accuracy for prediction of sequelae in congenital cytomegalovirus (cCMV) infected fetuses after maternal primary CMV infection. Study DesignWe conducted a prospective observational study between 1996 and 2012. 67 pregnant patients (69 fetuses) were included with serological evidences of maternal primary CMV infection and proven vertical transmission to the fetus (positive CMV viral load on amniotic fluid or positive viral culture of the neonate). Fetal US was performed in all patients. Termination of the pregnancy (TOP) was presented as an option for CMV infected fetuses. Hearing and neurological clinical assessments were performed for all neonates with a CMV positive urine sampling. We conducted a prospective observational study between 1996 and 2012. 67 pregnant patients (69 fetuses) were included with serological evidences of maternal primary CMV infection and proven vertical transmission to the fetus (positive CMV viral load on amniotic fluid or positive viral culture of the neonate). Fetal US was performed in all patients. Termination of the pregnancy (TOP) was presented as an option for CMV infected fetuses. Hearing and neurological clinical assessments were performed for all neonates with a CMV positive urine sampling. Results67 patients (69 fetuses) with a proven vertical transmission were included in this study, 64 singleton pregnancies and 3 twin pregnancies. 8 fetuses were excluded from the analysis because of insufficient data on the outcomes. Of the remaining 61, TOP was performed for 26 fetuses. In this group, 11 presented fetal US anomalies. Autopsy confirmed histological evidences of fetal CMV infection in all cases. In the 15 fetuses without fetal US anomalies, histological evidence of fetal infection damage was detected in 13 cases. Of the 35 live born infants, 12 had fetal US anomalies suggestive for cCMV infection. Of these 12 infants, 6 had a normal clinical evaluation whereas 6 presented with clinical anomalies from whom 4 cases were considered as severe. In 23 live born children with normal fetal US, 6 infants showed hearing impairments and 2 were diagnosed with mild neurological sequelae. 67 patients (69 fetuses) with a proven vertical transmission were included in this study, 64 singleton pregnancies and 3 twin pregnancies. 8 fetuses were excluded from the analysis because of insufficient data on the outcomes. Of the remaining 61, TOP was performed for 26 fetuses. In this group, 11 presented fetal US anomalies. Autopsy confirmed histological evidences of fetal CMV infection in all cases. In the 15 fetuses without fetal US anomalies, histological evidence of fetal infection damage was detected in 13 cases. Of the 35 live born infants, 12 had fetal US anomalies suggestive for cCMV infection. Of these 12 infants, 6 had a normal clinical evaluation whereas 6 presented with clinical anomalies from whom 4 cases were considered as severe. In 23 live born children with normal fetal US, 6 infants showed hearing impairments and 2 were diagnosed with mild neurological sequelae. ConclusionIn a group of maternal primary CMV infection acquired in early pregnancy, with proven fetal infection, fetal US anomalies were detected in 37,7% and were confirmed in autopsy or clinical evaluation after birth in 73,9%. In patients with normal fetal US evaluation, autopsy or clinical evaluation after birth could detect CMV-related anomalies in 55% of the patients. In a group of maternal primary CMV infection acquired in early pregnancy, with proven fetal infection, fetal US anomalies were detected in 37,7% and were confirmed in autopsy or clinical evaluation after birth in 73,9%. In patients with normal fetal US evaluation, autopsy or clinical evaluation after birth could detect CMV-related anomalies in 55% of the patients.